- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $398.11 / $602.56
| Facility | | $95.50 | $398.11 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.20 / $38.90 / $47.86
| Facility | 26 | $30.20 | $38.90 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $93.33 / $302.00
| Professional | | $46.77 | $93.33 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.84 / $57.54 / $114.82
| Professional | 26 | $28.84 | $57.54 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $54.95 / $144.54 / $616.60
| Professional | 50 | $54.95 | $144.54 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $43.65 / $58.88 / $134.90
| Professional | TC | $43.65 | $58.88 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $77.62 / $128.82
| Professional | | $63.10 | $77.62 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.99 / $32.36 / $56.23
| Professional | 26 | $23.99 | $32.36 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $93.33 / $97.72 / $114.82
| Professional | 50 | $93.33 | $97.72 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $45.71 / $70.79 / $95.50
| Professional | TC | $45.71 | $70.79 | $95.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $234.42 / $346.74
| Facility | | $83.18 | $234.42 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $83.18 / $134.90
| Professional | | $75.86 | $83.18 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.18 / $33.11 / $53.70
| Professional | 26 | $28.18 | $33.11 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $114.82 / $123.03 / $204.17
| Professional | 50 | $114.82 | $123.03 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $47.86 / $50.12 / $81.28
| Professional | TC | $47.86 | $50.12 | $81.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $58.88 / $104.71
| Facility | | $35.48 | $58.88 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $53.70 / $100.00
| Professional | | $33.11 | $53.70 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $346.74 / $346.74
| Facility | | $128.82 | $346.74 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $107.15 / $173.78
| Professional | | $70.79 | $107.15 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $27.54 / $41.69 / $64.57
| Professional | 26 | $27.54 | $41.69 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $43.65 / $64.57 / $107.15
| Professional | TC | $43.65 | $64.57 | $107.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $74.13 / $114.82
| Facility | | $60.26 | $74.13 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $93.33 / $158.49
| Professional | | $72.44 | $93.33 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.84 / $37.15 / $69.18
| Professional | 26 | $28.84 | $37.15 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $125.89 / $125.89 / $125.89
| Professional | 50 | $125.89 | $125.89 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $45.71 / $54.95 / $95.50
| Professional | TC | $45.71 | $54.95 | $95.50 |